Age-related Macular Degeneration (AMD) is a slow, age-related deterioration of the macula — the part of the retina responsible for sharp central vision. It is the leading cause of central vision loss after the age of 60. AMD does not cause complete blindness — the side (peripheral) vision is preserved — but it makes reading, recognising faces, driving and detailed work difficult.

The Two Types of AMD

AMD comes in two main forms, both starting from the same underlying ageing changes:

• Dry AMD — the more common form (about 85% of cases). The macula slowly thins and accumulates deposits called drusen. Vision loss is gradual.
• Wet AMD — less common (about 15% of cases) but causes most of the severe vision loss. Abnormal new blood vessels grow under the retina, leak fluid or blood, and rapidly damage the macula.

About 10–15% of patients with dry AMD will eventually develop wet AMD in one or both eyes. That is why anyone with dry AMD needs regular monitoring.

Symptoms

Early AMD

• Often no symptoms at all — the diagnosis is made on routine eye exam
• Mild blurring or difficulty reading small print
• Slightly slower adaptation when moving from bright light to dim light

Advanced dry AMD (geographic atrophy)

• A central blurred or dark area that gradually expands
• Faces become harder to recognise
• Reading becomes slow and tiring

Wet AMD

• Sudden distortion of straight lines
• A new dark spot or smudge in the centre of vision
• Sudden drop in central vision over days or weeks
• Difficulty reading or doing fine work that was easy a week before

Who Is at Risk?

• Age over 60 — the strongest risk factor
• Family history of AMD
• Smoking — doubles the risk; the most important modifiable factor
• High blood pressure and cardiovascular disease
• Long-term UV exposure without protection
• Poor diet, obesity, low intake of green leafy vegetables and fish
• Light iris colour (in some populations)

How We Diagnose AMD

• Dilated retinal examination — the first step; drusen, pigment changes and bleeds are usually visible
• OCT — the most important test. Shows drusen, fluid, atrophy and bleeds in cross-section
• OCT-Angiography — detects abnormal new vessels (CNV) without any dye injection
• Fundus autofluorescence (FAF) — maps areas of retinal cell loss
• Fluorescein angiography and ICG angiography — for difficult cases, especially when ruling out polypoidal disease (PCV)
• Amsler grid — for self-monitoring at home

Treatment

For Dry AMD

There is no medicine that fully cures dry AMD, but several steps slow the disease meaningfully:

• AREDS2 vitamins — a specific combination of antioxidants, lutein, zeaxanthin and zinc reduces the risk of progression to advanced AMD by about 25% in eligible patients.
• Diet rich in green leafy vegetables, fish, nuts and fruit.
• Quit smoking completely.
• Blood pressure and cardiovascular health.
• UV protection — sunglasses and a hat outdoors.
• Amsler grid weekly to catch conversion to wet AMD early.
• Newer therapies for geographic atrophy (complement inhibitors) are emerging — we will advise if you are a candidate.

For Wet AMD

• Intravitreal anti-VEGF injections — the cornerstone of wet AMD treatment. Drugs used include Ranibizumab, Aflibercept, Brolucizumab, Faricimab and Bevacizumab. The standard plan is three monthly loading injections, then maintenance based on OCT response.
• Photodynamic Therapy (PDT) — mainly for polypoidal lesions; sometimes combined with anti-VEGF.
• Submacular surgery — rarely needed, for very large submacular bleeds.

What to Expect from Treatment

• Wet AMD: Most patients stabilise; many gain some vision. Treatment is long-term — usually injections every 4–12 weeks, individualised.
• Dry AMD: AREDS2 and lifestyle slow progression. Most patients keep useful vision for many years if monitored.
• Both eyes need to be followed separately — AMD often develops in the second eye later.

Prevention & Self-Care

• Do not smoke (or stop, if you do)
• Eat green leafy vegetables, oily fish, fruits and nuts regularly
• Maintain healthy blood pressure and weight
• Wear UV-protective sunglasses outdoors
• Amsler grid weekly if you have early AMD or a family history
• Yearly dilated retinal exam after age 50; sooner if symptoms appear
• Discuss AREDS2 supplements with us if you have intermediate or advanced AMD in one eye

When to Come to Us Immediately

A new dark spot, new distortion of straight lines, a sudden drop in central vision — come the same day. Wet AMD treated within days has a far better outcome than wet AMD treated after weeks.